4 Questions
What is the third leading cause of death?
Stroke
According to the content, how often does someone have a stroke in the USA?
Every 45 seconds
COVID-19 is a risk factor for stroke.
True
The economic burden of stroke in 2017 was ______ Euros per year in the EU country study.
60 billion
Study Notes
Stroke Overview
- Stroke is the third leading cause of death, ranking behind cardiac disease and all forms of cancer.
- It is a leading cause of serious, long-term disability.
- Every 45 seconds, someone in the USA has a stroke, and every 3 minutes, someone dies of one.
- Stroke can account for about half of all hospital admissions for acute neurological disease (depending on the country).
- The economic burden of this disease is tremendous, with a 2017 figure of 60 billion Euros (EU country study) per year.
Risk Factors
- High Blood Pressure (Hypertension) - risk doubles with every 7.5mm increase in diastolic BP.
- Heart Disease
- Vascular Disease
- Diabetes Mellitus
- Diet/High Cholesterol
- Alcoholism
- Poor Health
- Smoking
- Contraceptive Pill (3 times increased risk)
- COVID-19 (21% of SARS-CoV-2/Covid-19 patients have both neurological symptoms and thromboembolic events)
Pathophysiological Mechanisms of COVID-19
- Cytokine Storm – proinflammatory cytokines (role of IL6)
- Coagulation dysfunction: triggers coagulation/blood clot pathway
- CNS invasion: infects endothelial cells/Blood Brain Barrier
- Angiotensin converting enzyme 2 (ACE2) expressed in heart/blood vessels/gut/lung/kidneys
- ACE2 in Brain: on neurons, glial cells, cerebral blood vessel endothelium
- Covid-19 binds to ACE2 and “hijacks” to gain CNS entry via ACE2
- ACE2 expression 3X higher in adult males to females
Treatment Options
- Physiotherapy
- Re-Open the vascular occlusion with thrombolytic agents (clot-busters) - Tissue Plasminogen Activator (t-PA), Streptokinase/Urokinase
- Prevent reocclusion – antithrombolytic therapy - Aspirin
- Many failed Clinical Trials!
- Future therapies?
Stroke Prevention and 2nd Stroke Prevention
- Anticoagulants
- Antihypertensive agents
- Anti-platelet agents
- Vitamins
- Stop smoking; healthy diet!
Mechanical Intra-Arterial Thrombectomy (Clot Retrieval)
- Only applicable to “large vessel” strokes
- Small subgroup (less than 2%) of stroke patients who fail to improve following intravenous Tissue Plasminogen Activator (t-PA) where the blocked vessel fails to open
Polytherapy Proposal
- Proposal to reduce ischaemic heart disease and stroke by 1/3rd in over 55-year-olds, gaining 11 years of life
- Proposed formulation: Statin (cholesterol-lowering) + 3 BP lowering agents + Folic acid (to lower homocysteine) + Aspirin (antiplatelet)
Clinical Trials
- Clinical trials in stroke and cardiovascular disease
- In 2015, over 3500 different interventions including drug, surgery, aftercare, and nothing!
- In 2020, 1908 stroke trials registered with the clinical trial center listing: “centerwatch”/search “stroke”: www.centerwatch.com
Other Relevant Information
- Sekerdag et al. (2018) - Cell death mechanisms in stroke and novel molecular and cellular treatment options
- Wu and Tymianski (2018) - Targeting NMDA receptors in stroke: new hope in neuroprotection
- Jayaraj et al. (2019) - Neuroinflammation: friend and foe for ischemic stroke
- Das et al. (2019) - Treatment approaches to Lacunar Stroke
- Chrostek et al. (2019) - Efficacy of stem cell-based therapies for stroke
Learn about the prevalence and impact of strokes, including mortality rates, hospital admissions, and economic burden.
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